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Updated: Jun 5, 2026
Thoracoscopic Extended Right Middle Plus Lower Sleeve Lobectomy for Non-Small-Cell Lung Cancer
Published on: February 27, 2026
Upfront surgery for clinical single-station N2 non-small cell lung cancer: real-world outcomes and implications for
Masatoshi Kanayama1, Manabu Yasuda2, Toshihiro Osaki3
1Department of Chest Surgery, Iizuka Hospital, 3-83 Yoshio-machi, Iizuka, 820-8505, Japan. masatoshi-kanayama@med.uoeh-u.ac.jp.
Objective:
Although neoadjuvant chemoimmunotherapy is increasingly adopted, the optimal treatment strategy for patients with clinical single-station N2 (cN2a) non-small cell lung cancer (NSCLC) remains controversial in real-world practice.
Methods:
We retrospectively analyzed patients with cN2a NSCLC who underwent upfront surgery between 2007 and 2022. Surgical details, pathological staging, adjuvant treatment, and outcomes were assessed.
Results:
Fifty-three patients were included. Concordance between clinical and pathologic nodal status (cN2a vs. pN2a) was observed in 39.6% of patients; 35.8% were downstaged, and 24.5% were upstaged to multi-station N2 (pN2b). Median overall survival and recurrence-free survival (RFS) were 60.1 and 25.6 months. Among patients with pathologic N2 disease, recurrence or death within 1 year occurred in 42.8% of those with pN2a and 76.9% with pN2b, primarily due to distant metastases. Adjuvant chemotherapy was administered to 50.9% of the patients. In patients with pN2a, median RFS was 57.8 and 25.3 months with and without adjuvant chemotherapy, respectively (p = 0.916). In patients with pN2b, median RFS was 9.7 and 3.5 months, respectively (p = 0.104).
Conclusions:
Upfront surgery remains a feasible approach for carefully selected patients with cN2a NSCLC. However, high early recurrence rates, even after adjuvant chemotherapy, highlight the need for more effective perioperative systemic control.
